9509-603 Lockwood
Lockwood T.
High-lateral-tension abdominoplasty with superficial fascial system suspension.
Plast Reconstr Surg. 1995 Sep;96(3):603-15. PMID: 7638284
Comment in:
Plast Reconstr Surg. 1996 Jul;98(1):184-5.
Plast Reconstr Surg. 2001 Aug;108(2):577-8.
Modern abdominoplasty techniques were developed in the 1960s. The advent of
liposuction has reduced the need for classic abdominoplasty and allowed more
aesthetic sculpting of the entire trunk. However, the combination of significant
truncal liposuction and classic abdominoplasty is not recommended due to the
increased risk of complications. Although the surgical principles of classic
abdominoplasty certainly have stood the test of time, they are based on two
theoretical assumptions that may be proved to be inaccurate. The first
assumption is that wide direct undermining to costal margins is essential for
abdominal flap advancement. In fact, discontinuous undermining allows effective
loosening of the abdominal flap while preserving vascular perforators. The
second inaccurate assumption is that with aging and weight fluctuations
(including pregnancy), abdominal skin relaxation occurs primarily in the
vertical direction from the xiphoid to the pubis. This is true in the lower
abdomen, but in most patients a strong superficial fascial system adherence to
the linea alba in the epigastrium limits vertical descent. Epigastric laxity
frequently results from a progressive horizontal loosening due to relaxation of
the tissue along the lateral trunk. Experience with the lower-body lift
procedure has shown that significant lateral truncal skin resection results in
epigastric tightening. In these patients, the ideal abdominoplasty pattern would
resect as much or more laterally than centrally, leading to more natural
abdominal contours. Fifty patients who underwent high-lateral-tension
abdominoplasty with and without significant truncal liposuction and other
aesthetic procedures were followed for 4 to 16 months. The primary indication
for surgery was moderate to severe laxity of abdominal skin and muscle with or
without truncal fat deposits. Complication rates were equal to or less than
those of historical controls and did not increase with significant adjunctive
liposuction. The key technical elements of this procedure include direct
undermining limited to the paramedian area, discontinuous undermining to costal
margins and flanks as needed, skin resection pattern with significant lateral
resection and highest-tension wound closure placed laterally, superficial
fascial system repair with permanent sutures along the entire incision, and
liberal use of adjunctive liposuction in the upper abdomen and the lateral and
posterior trunk.
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